Healthcare Provider Details

I. General information

NPI: 1083642003
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF ST. LOUIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEMORIAL DRIVE
ALTON IL
62002-6722
US

IV. Provider business mailing address

PO BOX 1125
MARYLAND HEIGHTS MO
63043-0125
US

V. Phone/Fax

Practice location:
  • Phone: 618-463-7311
  • Fax:
Mailing address:
  • Phone: 888-731-1036
  • Fax: 423-892-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. HANY B TADROS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 423-424-3829